Grade 3 AC Joint Separation, Share your experience Post-Surgery swimming, strength training, cycling, and other shoulder-based movements!: Triathlon Forum: Slowtwitch Forums

Grade 3 AC Joint Separation, Share your experience Post-Surgery swimming, strength training, cycling, and other shoulder-based movements!

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sports

Apr 28, 19 7:36

Post #1 of 18 (3982 views)

Hi Slowtwitch,

I am looking for input about a Grade 3 AC Joint Separation, and your experiences with surgery for this injury. During my last race, I was seriously injured, among the injuries resulting from the accident is a Grade 3 AC Joint Separation. During the bike leg of the race, I had to brake suddenly to avoid a collision, and went over the handlebars of my bike.

I will be meeting a shoulder surgeon, and want to be as informed as I can be.

Please share your experiences and knowledge of what it is like to have surgery, and how your workouts and training are after recovery from surgery. ...How the shoulder feels during swims, strength training, cycling, and any activity involving shoulder movement post-surgery.
• I'd love to hear how a one hour swim feels, how strength training with weights is going (I have pain that makes me stop doing bench press, chest fly, and cable adduction), and do you feel pain from leaning on handlebars while cycling?

I feel pain during my masters swim workouts, and the "crunching" of the scar tissue (injury is 8 months old) during bench press, chest fly, cable horizontal adduction causes pain that makes me stop doing the movement. This is a huge disappointment, as I love to strength train in addition to swim, bike, and run.

The scar of this injury is the worst kind for me: skeletal disfigurement. I am a female, and though eight months have gone by, I cringe when I see the deformity in the mirror at the gym. Summer is coming, and it will be more obvious wearing tank tops and smooth fabric shirts. Even when I tell myself it is only a bump, the sight is disconcerting and gross - especially as you can see the end of my clavicle moving back and forth when I run, or use elliptical machine, or when I pull a resistance band. My arm appears to hang lower than the other side with these (AC and CC) ligaments torn, scar tissue in their place.

I've read all the old threads from 2008-2011 about AC Joint Separations, hoping to find more recent information. Thanks!

Looking forward to hearing about this!

Last edited by: sports: Apr 28, 19 8:13

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Re: Grade 3 AC Joint Separation, Share your experience Post-Surgery swimming, strength training, cycling, and other shoulder-based movements! [sports] [ In reply to ]

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DBF

Apr 28, 19 9:03

Post #2 of 18 (3952 views)

The Surgery is rough. Expect quite a bit of pain and not too much mobility for weeks. The PT is straightforward. You might be swimming with fins in six or eight weeks. You can get on the trainer in three or four days sitting straight up.
I did a complete separation and a broken collarbone February 1 and raced Lake Placid that year in July with a fairly normal swim split.

There are a tremendous amount of nerve endings in your shoulder so when they tell you to take the pain medication for a few days don’t wait till it hurts, just take that bullshit for a couple days and then stop.
I of course didn’t take any pain medication and the pain was overwhelming for 12 hours or so with the nerve block wore off, way worse than actually breaking it.
I seem to remember my shoulder getting back to 90% in four or five months but a couple years before it was 100%.

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Re: Grade 3 AC Joint Separation, Share your experience Post-Surgery swimming, strength training, cycling, and other shoulder-based movements! [sports] [ In reply to ]

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WannaB

Apr 28, 19 15:47

Post #3 of 18 (3908 views)

Grade 4/5 over the handlebars (mtb bike).

I saw a really good shoulder specialist who is team physician for local pro hockey team. She said in her opinion I was on the cusp, could go either way. Surgery was mostly going to be for cosmetics down the line. And surgery carried more prolonged period of immobility and recovery before could even start PT.

I elected to not go with surgery. Pain started to subside around week 4. Was able to start PT. I recovered 95% of my strength and mobility. It still clicks from time to time , but no pain. I was able to start cycling around 8-10 weeks (I can't remember), swimming in 12 weeks. I would say it was a full year before I felt fully recovered and back to baseline.

I am five years out, felt like right decision for me. I have done many races since. I do have an obvious step off, and you can tell immediately from the beach. But, nobody is looking. Alas....

That is my 2 cents. Any good surgeon should be able to give you their opinion with or without. And what they would do if it was them.

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Re: Grade 3 AC Joint Separation, Share your experience Post-Surgery swimming, strength training, cycling, and other shoulder-based movements! [sports] [ In reply to ]

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garwood

Apr 28, 19 16:48

Post #4 of 18 (3890 views)

Everyone is different.

Andrew Garwood
http://www.2xu.com
http://www.newtonrunning.com
http://www.ascendsport.com.au

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Re: Grade 3 AC Joint Separation, Share your experience Post-Surgery swimming, strength training, cycling, and other shoulder-based movements! [sports] [ In reply to ]

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wannabefaster

Apr 28, 19 17:20

Post #5 of 18 (3883 views)

I had a complete separation/disruption of the acromioclavicular ligament in 1992. My old-school orthopedic surgeon said that it was an incredibly common injury, especially among hockey players (I did mine an a bike crash). He recommended to me that I not get it repaired and so I didn't.

It took about a year to recover completely but I have never had an issue since. Shoulder is totally functional. I can swim, do pushups, pullups, etc.

I have no regrets about not having surgery on my shoulder.

ETA: yes, it is a little "different" looking. Maybe, as a guy, I am less burdened by this. Also, I did occasionally have some tissue get stuck in the space between the ends of the bones, which you hinted at, for a couple years. This went away and hasn't recurred in 20+ years.

----------------------------
Jason
None of the secrets of success will work unless you do.

Last edited by: wannabefaster: Apr 28, 19 17:23

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Re: Grade 3 AC Joint Separation, Share your experience Post-Surgery swimming, strength training, cycling, and other shoulder-based movements! [wannabefaster] [ In reply to ]

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PatMcNichol61

Apr 29, 19 12:53

Post #6 of 18 (3795 views)

I had a pretty bad spill on the bike a few years ago and separated and dislocated by shoulder (before then, I though that was the same thing). I went to the Doc for advice thinking I was a candidate for surgical repair, but he gave me a sheet of bands exercises to do (internal and external rotation, etc.). I always always a gym rat, and stuck with it, and my right shoulder is about as recovered as it will ever be. I did have to adapt to the new normal, though. While I could swim a little a week after the accident, being in the aero position on my TT bike was hell. That probably took a full year to get back.

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Re: Grade 3 AC Joint Separation, Share your experience Post-Surgery swimming, strength training, cycling, and other shoulder-based movements! [PatMcNichol61] [ In reply to ]

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elf6c

Apr 29, 19 13:00

Post #7 of 18 (3789 views)

Same- grade 3, with bonus broken scapula and 3 broken ribs. Trusted docs I knew advised rehab over surgery, that's the route I went. Shoulder works pretty well, can swim and do push-ups. There are a few minor things it doesn't like, so I don't do those things.

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Re: Grade 3 AC Joint Separation, Share your experience Post-Surgery swimming, strength training, cycling, and other shoulder-based movements! [sports] [ In reply to ]

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Blmgtnbkr

Apr 29, 19 14:04

Post #8 of 18 (3763 views)

>Summer 2017, bad bike crash. Broken clavicle, twisted radius bone, concussion and split my humerus. 11 screws and a plate in the left shoulder. They had to cut thru my rotator cuff to get the plate in there. Funny thing is that it doesn't hurt when I swim, only when I run.

The surgeon said to let the collar bone heal without any hardware. So the bone healed kinda like at an angle & sticks up. Doc wanted to make sure I could swim & said he was aiming for 90% mobility. He exceed that...real close to 100%. Probably 2 weeks after surgery I was doing PT 3x/week. Both the Doc & PTs "pushed" me to get into the water. Started with just kicking (stretch out that arm a little bit further each time), then breast stroke, 1 arm free, then stroke 2x right arm & 1x left. After about 4 months I was doing 3-4k yds/3x week.

There was some discomfort when I first started swimming, but none since those first few weeks post surgery. I have been doing TRX for quick a few years and I believe that has helped tremendously with the range of motion initially and then adding strength to the shoulder area post surgery.

Like mentioned above, getting in aero position was awkward for about 9-11 months after surgery.

"I cringe when I see the deformity in the mirror"... I can understand that. My Clavicle has that "peak" where it healed together and I can position my shoulder a certain way to really make it pronounced. Many will stare at that and the scar on the front of the shoulder.

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Re: Grade 3 AC Joint Separation, Share your experience Post-Surgery swimming, strength training, cycling, and other shoulder-based movements! [Blmgtnbkr] [ In reply to ]

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McNulty

Apr 29, 19 15:47

Post #9 of 18 (3738 views)

big lump as I didn't get it pinned, then years later i shattered my clavicle same side, plate and 7 pins.............all good, no issues except the lump and maybe a little less strength/support but same flexibility.....

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Re: Grade 3 AC Joint Separation, Share your experience Post-Surgery swimming, strength training, cycling, and other shoulder-based movements! [McNulty] [ In reply to ]

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zedzded

Apr 29, 19 15:58

Post #10 of 18 (3737 views)

Grade 4 ac dislocation, had a screw and anchor. 2 months in a sling. Was back playing rugby 6 months later. No issues 15 years down the track other than I can't sleep on that side.

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Re: Grade 3 AC Joint Separation, Share your experience Post-Surgery swimming, strength training, cycling, and other shoulder-based movements! [sports] [ In reply to ]

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wannabefaster

Apr 30, 19 3:32

Post #11 of 18 (3682 views)

The thing I forgot to mention but I’m sure I have mentioned in past threads about this: one of the reasons my surgeon argued against repair was that he guaranteed me arthritis of the AC joint down the road if it were repaired.

I guess with complete disruption there is no real joint to develop arthritis but if you put the ends back together that eventually arthritis will develop.

I’m not sure if anyone is far enough down the road after repair to confirm or deny this but that was the final piece that convinced me not to get it repaired.

----------------------------
Jason
None of the secrets of success will work unless you do.

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Re: Grade 3 AC Joint Separation, Share your experience Post-Surgery swimming, strength training, cycling, and other shoulder-based movements! [sports] [ In reply to ]

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RJSuperfreaky

Apr 30, 19 7:41

Post #12 of 18 (3647 views)

Had this exact injury 2 years ago after a crash. Saw a shoulder specialist, and he said the outcomes from Grade 3 are nearly equivalent between operation and non-op. I did PT for almost 3 months, and then slowly started swimming. Now, 2 years later, back to swimming as I was before, but with weights I have to be careful, and there are certain moves that feel more "unstable" than others. I really worked on strengthening my shoulder muscle girdle, and that seems to help. Still can't sleep on that side, and will likely always have some arthritis and some pain at times, but otherwise nearly back to normal.

I am a surgeon, but not a shoulder surgeon, and would be very hesitant to get an operation on your shoulder unless absolutely indicated and strongly recommended by your surgeon, as any surgeon worth his/her salt will tell you that shoulder outcomes are not as good as other joints, and you may be trading one set of issues for another.

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Re: Grade 3 AC Joint Separation, Share your experience Post-Surgery swimming, strength training, cycling, and other shoulder-based movements! [RJSuperfreaky] [ In reply to ]

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JASpencer

Apr 30, 19 9:29

Post #13 of 18 (3631 views)

RJSuperfreaky wrote:

I had a similar experience (timing as well). VERY bad bump that LOOKS terrible and FEELS very unstable. That being said I'm swimming better than ever with no pain, soreness, or discomfort. Unfortunately, bench presses and shoulder presses cause a lot of discomfort and some soreness (pushups too). I'm good enough now but still often wonder if having surgery would have put me back to 100%.

Again...functionally I'm 90% there but I still feel delicate 2 years later.

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Re: Grade 3 AC Joint Separation, Share your experience Post-Surgery swimming, strength training, cycling, and other shoulder-based movements! [sports] [ In reply to ]

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TwoDollarSteak

Apr 30, 19 9:52

Post #14 of 18 (3628 views)

I'm almost 11 months from a cycling accident where I fractured my collarbone in five places, shattered the distal end of my shoulder, and separated my AC.

I saw a specialist and they did both surgeries in one go, five days later. I have permanent hardware from the clavicle ORIF -- plates and screws.

I was in a sling for 6.5 weeks. I started basic movements like pendulums and pot-stirrers immediately after surgery. I was able to get on my bike trainer the day I got my stitches out (3 weeks post-accident) and put a pole next to the bike for support to make getting on/off easier. I started a PT program the following week and "running" a week after that. I didn't swim for 7.5 weeks which was about the same time as when I returned to strength training under the watchful eye on my PT.

I was VERY diligent about my PT and rehab and had a successful return to racing about four months later (shout-out to my coach, DarkHorseTri, for excellent and patient programming). Feel free to PM me if you want the details of my PT/Rehab or if you want specifics on the timeline (I chronicled a bunch on IG).

As for the disfigurement, I won't mince words: my scar is big and it still doesn't quite look like my left clavicle. The scar runs from the middle of my chest to the end of my shoulder and is visible in most clothing. It's not my first scar but it's by far the most noticeable. I like to think of it as a unique part of me and am reminded of the Japanese practice of Kintsuji which repairs broken objects with precious metal to celebrates a break instead of disguising it. YMMV on that philosophy but it works for me.

Good luck and don't hesitate to reach out.

(Formerly SoCalTricurious, now in the PNW).

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Re: Grade 3 AC Joint Separation, Share your experience Post-Surgery swimming, strength training, cycling, and other shoulder-based movements! [JASpencer] [ In reply to ]

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jsk

Apr 30, 19 14:23

Post #15 of 18 (3592 views)

JASpencer wrote:

Yours sounds similar to mine. Ortho recommended against surgery, said I should expect full recovery. I don't really feel like I fully recovered though(it's been over a year now). I don't get any discomfort and range of motion is fine; but I get a fair amount of grinding/clicking with certain motions, it's it definitely feels weaker and less stable than I'd like. The biggest issue for me is that I can't really lift weights anymore; any kind of pressing exercise is just too painful, except for incline bench (with really light weight). As someone who has always lifted, that's pretty disappointing for me. I've been considering revisiting the surgery idea, but reading the feedback here it doesn't really sound worth it (especially if it's long, painful recovery).

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Re: Grade 3 AC Joint Separation, Share your experience Post-Surgery swimming, strength training, cycling, and other shoulder-based movements! [sports] [ In reply to ]

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Geronimo

Apr 30, 19 19:49

Post #16 of 18 (3564 views)

Everyone’s experience will be totally different, but I would not be eager to rush into surgery unless your doctors think it makes sense for you. Ask your surgeon if he or she has worked with athletes, maybe find one who has if not to at least consult with them on your situation.

I had a grade 4 (I think? Total separation with some complications), and total reconstruction surgery. Screws, a plate, putting back together the rotator cuff, the whole deal. The comeback felt very long for me. Six months till I was allowed to see the field, and I really didn’t feel 100% for closer to 18 (but coming back to rugby, so different deal).

Strength training was odd, absolute strength came back pretty quickly, but it took a very long time to build up conditioning in that shoulder. If I were you now, I’d do floor presses instead of on a bench, it will prevent the shoulder from getting into a dangerous position.

Also, if you’re worried about appearance, the arm will probably droop less over time, and weigh that against the scar from surgery.

All that said, it’s been five years now, and it feels completely fine in an hour swim, long pushup sets, deep dip sets, etc.

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Re: Grade 3 AC Joint Separation, Share your experience Post-Surgery swimming, strength training, cycling, and other shoulder-based movements! [sports] [ In reply to ]

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Mark57

Apr 30, 19 21:51

Post #17 of 18 (3544 views)

Same injury, ie over the top plus 2 # ribs. Non dominant arm which made it easier. 2-3 month of boring rehab exercises after surgery but back to work after a month. Able to KQ the next year if that gives you hope.There is still a noticeable lump made worse when I drop my shoulders but no pain. My head hit the ground pretty hard and I fractured a tooth which became evident months later. All I can say is thank God for the helmet.
PS I've noticed I'm doing more riding on the trainer these days!

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Re: Grade 3 AC Joint Separation, Share your experience Post-Surgery swimming, strength training, cycling, and other shoulder-based movements! [sports] [ In reply to ]

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